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Most adults and older children have several respiratory infections each year. Respiratory problems can be as minor as the common cold or as serious as pneumonia. They may affect the upper respiratory system (nose, mouth, sinuses, and throat) or the lower bronchial tubes and lungs. See a picture of the respiratory system.
Upper respiratory system
The upper respiratory system includes the nose, mouth, sinuses, and throat. When you have an upper respiratory infection, you may feel uncomfortable, have a stuffy nose, and sound very congested. Other symptoms of an upper respiratory infection include:
- Facial pain or pressure.
- A runny or stuffy nose, which may lead to blockage of the nasal passages and cause you to breathe through your mouth.
- A sore throat.
- Irritability, restlessness, poor appetite, and decreased activity level.
- Coughing, especially when lying down.
- Fever that occurs suddenly and may reach 103°F (39°C) or higher.
Lower respiratory system
The lower respiratory system includes the bronchial tubes and lungs. Respiratory problems are less common in the lower respiratory system than upper respiratory system.
The symptoms of a lower respiratory (bronchial tubes and lungs) problem usually are more severe than symptoms of an upper respiratory (mouth, nose, sinuses, and throat) problem.
Symptoms of lower respiratory system infections include:
- Cough, which continues throughout the day and night, often producing green, yellow, brown, or gray mucus (sputum) from the lungs.
- Fever, which may be high with some lower respiratory system infections such as pneumonia.
- Difficulty breathing. You may notice:
- Shortness of breath.
- Grunting, which is heard during the breathing out (exhaling) phase of breathing.
- Flaring the nostrils and using the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
- Chest pain with exertion or when you take a deep breath.
Respiratory problems may have many causes.
Viral infections are the most common cause of upper respiratory symptoms. Symptoms of a viral illness often come on quickly (over hours to a day or two) without prior illness. Common viral illnesses include colds and influenza (flu).
- Colds are minor upper respiratory illnesses that usually go away without treatment. Symptoms may include cough, mild sore throat, nasal congestion, runny nose or sneezing, and occasionally a fever.
- Influenza (flu) symptoms are usually more severe than a cold. The key symptoms in adults are fever and body aches. Headache, eye pain, muscle aches, and cough are also common. For more information, see the topic Influenza (Seasonal Flu).
Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes you to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.
Bacterial infections may develop after a viral illness, such as a cold or influenza, and are less common than viral illnesses. Bacterial infections may affect the upper or lower respiratory system. Symptoms tend to localize to one area. In the upper respiratory system, the most common sites of bacterial infections are the sinuses and throat. In the lower respiratory system, the most common site is the lungs (pneumonia).
Bacterial infections are more common in smokers, people exposed to secondhand smoke, and people with chronic lung disease (such as asthma or chronic obstructive pulmonary disease [COPD]) and other chronic medical problems. Antibiotics can effectively treat most bacterial infections.
Allergies, especially hay fever, are another common respiratory problem. Symptoms include sneezing, clear runny drainage from the nose and eyes, itchy eyes or nose, and stuffy, congested ears and sinuses. The symptoms of allergies often last longer than a typical viral respiratory infection. For more information, see the topic Allergic Rhinitis.
Asthma is a chronic disease of the respiratory system. It causes inflammation and narrowing in the tubes that carry air to the lungs (bronchial tubes). The inflammation leads to difficulty breathing, wheezing, tightness in the chest, and cough.
Asthma often begins during childhood and may last throughout a person's life. The cause of asthma is not clearly known. It is more common in people who also have allergies. For more information, see the topic Asthma in Children or Asthma in Teens and Adults.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
If you're not sure if a fever is high, moderate, or mild, think about these issues:
With a high fever:
- You feel very hot.
- It is likely one of the highest fevers you've ever had. High fevers are not that common, especially in adults.
With a moderate fever:
- You feel warm or hot.
- You know you have a fever.
With a mild fever:
- You may feel a little warm.
- You think you might have a fever, but you're not sure.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Symptoms of difficulty breathing can range from mild to severe. For example:
- You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
- It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you're at rest (severe difficulty breathing).
Severe trouble breathing means:
- You cannot talk at all.
- You have to work very hard to breathe.
- You feel like you can't get enough air.
- You do not feel alert or cannot think clearly.
Moderate trouble breathing means:
- It's hard to talk in full sentences.
- It's hard to breathe with activity.
Mild trouble breathing means:
- You feel a little out of breath but can still talk.
- It's becoming hard to breathe with activity.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
It is easy for your diabetes to become out of control when you are sick. Because of an illness:
- Your blood sugar may be too high or too low.
- You may not be able take your diabetes medicine (if you are vomiting or having trouble keeping food or fluids down).
- You may not know how to adjust the timing or dose of your diabetes medicine.
- You may not be eating enough or drinking enough fluids.
An illness plan for people with diabetes usually covers things like:
- How often to test blood sugar and what the target range is.
- Whether and how to adjust the dose and timing of insulin or other diabetes medicines.
- What to do if you have trouble keeping food or fluids down.
- When to call your doctor.
The plan is designed to help keep your diabetes in control even though you are sick. When you have diabetes, even a minor illness can cause problems.
Temperature varies a little depending on how you measure it. For adults and children age 12 and older, these are the ranges for high, moderate, and mild, according to how you took the temperature.
Oral (by mouth) temperature
- High: 104°F (40°C) and higher
- Moderate: 100.4°F (38°C) to 103.9°F (39.9°C)
- Mild: 100.3°F (37.9°C) and lower
A forehead (temporal) scanner is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.
Ear or rectal temperature
- High: 105°F (40.6°C) and higher
- Moderate: 101.4°F (38.6°C) to 104.9°F (40.5°C)
- Mild: 101.3°F (38.5°C) and lower
Armpit (axillary) temperature
- High: 103°F (39.5°C) and higher
- Moderate: 99.4°F (37.4°C) to 102.9°F (39.4°C)
- Mild: 99.3°F (37.3°C) and lower
Symptoms of a severe allergic reaction (anaphylaxis) may include:
- The sudden appearance of raised, red areas (hives) all over the body.
- Rapid swelling of the throat, mouth, or tongue.
- Trouble breathing.
- Passing out (losing consciousness). Or you may feel very lightheaded or suddenly feel weak, confused, or restless.
A severe reaction can be life-threatening. If you have had a bad allergic reaction to a substance before and are exposed to it again, treat any symptoms as an emergency. Even if the symptoms are mild at first, they may quickly become very severe.
Symptoms of a heart attack may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
The more of these symptoms you have, the more likely it is that you're having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it's hard for you to function).
- Shaking chills.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.
Sometimes people don't want to call 911 . They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Home treatment can help you feel more comfortable when you have mild to moderate respiratory symptoms.
- Prevent dehydration. Hot fluids, such as tea or soup, may help relieve congestion in your nose and throat. If you have a productive cough, fluids may help thin the mucus in your lungs so your cough can clear it out.
- Get extra rest; let your symptoms be your guide. If you have a cold, you may be able to stick to your usual routine and just get some extra sleep.
- Let yourself cough if you have a cough that brings up mucus from the lungs. It can help prevent bacterial infections. People who have chronic bronchitis or emphysema need to cough to help clear mucus from their lungs.
- For a sore throat, gargle at least once each hour with warm salt water [ 1 tsp ( 5 g) of salt in 8 fl oz (240 mL) of water] to reduce swelling and discomfort. For more information, see the topic Sore Throat and Other Throat Problems.
- Use a humidifier to add moisture to the air. Use only water in the humidifier.
- For a stuffy nose, use saline spray or nose drops to wash out mucus and germs.
Keep in mind the following guidelines for taking nonprescription medicine for your symptoms:
- Nonprescription medicines may not work very well for respiratory problems. And some of these medicines can cause problems if you use too much of them. It is important to use medicines correctly and to keep them out of the reach of children to prevent accidental use.
- Check with the doctor before giving decongestants, antihistamines, or other cold and allergy medicines to children.
- If you use a decongestant nasal spray, don't use it longer than the label says. Overuse may lead to a rebound effect, which causes the mucous membranes to become more swollen than they were before you started using the spray.
- If you have a dry, hacking cough that does not bring up any sputum, ask your doctor or pharmacist about an effective cough suppressant medicine. For more information, see the topic Coughs, Age 12 and Older.
- If you decide to try a dietary supplement such as echinacea or zinc, do not exceed the maximum recommended dose. If you have another health problem or take prescription medicines, talk with your doctor before taking an alternative medicine or supplement. For more information, see the topic Colds or Complementary Medicine.
Try a nonprescription medicine to help treat your fever or pain:
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Increasing difficulty breathing develops.
- Wheezing develops.
- New chest pain develops.
- Symptoms last longer than 2 weeks.
- Symptoms become more severe or frequent.
There is no sure way to prevent respiratory illnesses. To help reduce your risk:
- Wash your hands often, especially when you are around people with colds.
- Keep your hands away from your nose, eyes, and mouth. These are the places where viruses are most likely to enter your body.
- Do not smoke or use other tobacco products. Smoking irritates the mucous membranes of the nose, sinuses, and lungs, which may make them more susceptible to infections. For more information, see the topic Quitting Smoking.
- If you live in an area that has problems with air pollution or smoke from wildfires:
- Stay indoors and avoid breathing in smoke, ashes, or polluted air.
- Do not exercise outdoors if you smell smoke or notice irritation of your eyes, nose, or throat.
- Keep your motor vehicle windows rolled up and the vents closed when driving.
- Avoid cleanup activities, such as raking leaves or cutting brush.
- Avoid exposure to chemicals. Do not spray or apply chemicals unless you are wearing protective clothing, such as a particle-filtering respirator, safety goggles, and gloves.
- Exercise regularly. For more information, see the topic Fitness: Getting and Staying Active.
- Get a flu shot (influenza vaccine) each year. For more information, see the topic Influenza (Seasonal Flu).
- Get a pneumococcal shot if you have chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD); if you smoke; or if you have a health risk that increases the seriousness of your symptoms. If you are age 65 or older, it is recommended you get two different types of pneumococcal vaccines.
- Make sure your immunizations are current, such as pertussis to reduce your risk of getting whooping cough. For more information, see the topic Immunizations.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- When did your symptoms start?
- Is your respiratory problem localized, such as involving only one ear, one side of your sinuses, or the lungs?
- Did symptoms start as a cold but now appear to be worse than you would expect from a cold?
- Have you had similar symptoms before? How were they treated?
- Do you have a productive cough? Are you coughing up clear, white, green, yellow, or blood-tinged mucus? How much mucus are you bringing up? Are you coughing up mucus all day long or mostly at nighttime?
- Have you had fever and chills?
- Are you wheezing, or do you have new or worsening shortness of breath?
- Do you have a severe headache, earache, or sore throat?
- Do any other members of your family or work group have similar symptoms?
- Have you recently been exposed to large amounts of dust, fumes, smoke, or chemicals?
- Do you smoke or use other tobacco products?
- Have you recently used an indoor hot tub, pool, or spa?
- What home treatment have you tried? Did it help?
- What prescription, nonprescription, or alternative medicines have you tried? Did they help?
- Have you recently traveled inside or outside of your home country?
- Do you have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine